What is happening with Medicaid Expansion?
By Harriet Bachner
Congress passed the Affordable Care Act (ACA) 14 years ago; 10 years ago, Medicaid expansion was offered through the ACA; during those 10 years 40 states expanded Medicaid, and for the past seven years the Kansas legislature has not been able to expand Medicaid for the thousands of Kansans who desperately need health care. Many Kansans have massive debt due to uninsured medical expenses, often leading to inability to cover basic needs. In 2017, the Kansas legislature voted in favor of expansion, but Governor Brownback vetoed the legislation.
What is the “coverage gap”?
“The ACA expanded Medicaid to nonelderly adults with income up to 138 percent federal poverty level ($20,782 annually for an individual in 2024) with enhanced federal matching funds (now at 90 percent)” (Drake, Tolbert, Rudowitz, & Damico, 2024). Thus, the coverage gap includes those who have incomes between $12,800 and 138 percent above the federal poverty rate making them ineligible for subsidies in the ACA Marketplaces.
What happened during the 2024 Kansas legislative session?
Despite that 70 percent to 80 percent of Kansans (as shown in a survey from Fort Hays State University) want Medicaid expanded, the possibility of a vote on the legislation was defeated late this spring with 18 senators voting in favor and 17 voting against the bill proceeding to the Senate floor for open debate and an eventual vote. Our district senator, Tim Shallenberger, was absent from that vote.
Since the 2017 Brownback veto, the Kansas legislature has changed, and Governor Laura Kelly very much wants to expand Medicaid. In fact, during the 2024 legislative session, she travelled to cities and towns throughout Kansas, including Pittsburg, speaking to community groups, advocating for expansion. She explained the benefits of expansion for the local and state economy, the survival of rural hospitals, the retention of health care professionals, the criminal justice system, and most important, for those hard-working Kansans who fall in the “coverage gap.”
The Healthy Kansas Alliance (AHK)
The AHK has been working for years to educate the public about the need for expansion and to influence legislators to sponsor and vote in favor of expansion. This past spring they conducted informative sessions throughout Kansas, including Pittsburg, about the needs and benefits of expansion and discussed strategies to motivate legislators to support expansion. AHK held a rally in March at the capitol in Topeka with the attendees hearing from physicians, hospital administrators and citizens sharing their stories regarding the impact of not having access to healthcare because they are in the “coverage gap.” These stories were shared with legislators as well, either in personal meetings with their respective legislator or with representatives or senators in session. The AHK website (www.expandkancare.com) includes these personal stories and information about the issues related to Medicaid expansion and provides a perspective on the reasons this seemingly obvious need has met legislative, economic, and political hurdles. The August personal story features a Pittsburg resident who is a personal care attendant and is in the “coverage gap.”
What is happening now and what are the next steps in securing expansion?
The AHK has sponsored several events over the summer and projects for the fall preparing for the 2025 legislative session. They encourage continuing pressure on legislators through postcard, letter writing and letters to the editors of our community papers about the need for expansion. There are a variety of materials and talking points for letters and information about upcoming AHK sponsored events available on the AHK website. An example of an event is the Summer Bingo Community conversations. In fact, there will be one in Pittsburg in September (the date will be announced in August). AHK also has open community zoom meetings that “provide an opportunity to learn about Kancare expansion and focus on peer-to-peer advocacy and engagement” (AHK, 2024). The dates for the zoom meetings are listed on the website where folks can sign up to receive the link to attend. This summer the zoom meetings have presented ways to correct disinformation regarding Medicaid expansion in Kansas. These discussions have also been very helpful for talking to folks who present misinformation and disinformation heard from a variety of sources about current social and political issues. A few of the recommendations for dealing with disinformation include these.
1. Lead with our message to build resistance to disinformation and stop there.
2. Be selective and choose when and where to respond to disinformation.
3. Prepare for when disinformation may happen.
4. Educate about the positive or proactive to help folks know when to disregard disinformation.
5. Use logical correction as an inoculation to disinformation and help folks to think critically.
6. Keep in mind that folks remember what is heard first best, and do not lead with the opposition’s talking points.
Hope and VOTE
Amidst the social and political strife, there are reasons for hope. With the upcoming November election, we have an opportunity to vote for Kansas house representatives and Kansas senators who are amenable to expanding Medicaid. Much has been accomplished this past year in drawing attention to the need and desire for expansion and elected officials cannot ignore it. The stress on health care professionals, rural hospitals, and hard-working, low-income Kansans’ need for health care is profound. Their stories are being heard and recorded and thus cannot be trivialized by legislators who refer to them as not be willing to work. So, our vote is crucial in changing health care access in Kansas!
Drake,P., Tolbert,J., Rudowitz, R. & Damico. A. (2024, Feb. 26). How many uninsured are in the coverage gap and how many could be eligible if all states adopted the Medicaid expansion? KFF News. Retrieved from www.KFF.org
Alliance for a Healthy Kansas (2024). Retrieved from www.expandkancare.com
